Health Care Coordinators perform professional work related to program operations and auditing providers to ensure compliance with program policies and regulations.
Assess potential client needs for case management services using assessment tools to identify social service and/or medical needs; participate in periodic reviews of facilities providing care to Medicaid eligible clients to validate and ensure adequacy of services and resident care.
Review health care providers and fiscal agents to ensure clients are receiving appropriate services and payment is correct for services received, process payment authorization requests from providers to ensure the requested service, treatment, equipment or supplies are medically necessary and in compliance with Medicaid criteria prior to approving or denying requests.
Review records from the fiscal agent, providers, clients and computer generated reports in order to identify abuse and potential fraud and to ensure claims were paid properly by the fiscal agent.
Explain proper billing procedures to contract providers selected by the client; monitor the quality of care given by the provider to clients; and submit billings for services provided to the fiscal agent for payment.
This position is with the Department of Health and Human Services in the Division of Health Care Financing and Policy (DHCFP/Medicaid) and is located at the DHCFP Carson City District Office.
This position requires up to fifty percent of time traveling within the Carson City District Office catchment area.
Health Care Coordinators (HCC's) evaluate individuals referred to the medical services program and provide ongoing case management services to Medicaid eligible clients; evaluate the need for medical services, treatment, equipment and supplies and authorize payment; screen individuals to determine appropriate level of care in nursing homes; review programs and participate in program development.
This position would also conduct provider reviews and or site visits to evaluate for compliance of state and federal regulations or for provider enrollment requirements and report findings within short time constraints to contribute to the health, safety, and welfare of Medicaid recipients.
The selected applicant must obtain and maintain American Association of Nurse Assessment Coordinators (AANAC) certification to complete Minimum Data Set (MDS) reviews in long term care facilities.
Please ensure your application reflects your current nursing license information.
This should be included in the "license" section of your application.
State OF Nevada